Hospice Care for Sepsis/Septic Shock

Sepsis is different from other serious or chronic diseases that often lead
to a hospice diagnosis because of the speed at which it develops. If not
treated and addressed quickly, a sepsis-related infection can spread
quickly throughout the body and worsen, often within a matter of hours or a
few days. As soon as sepsis is diagnosed, it should be brought to the
immediate attention of hospice admissions personnel, because that’s when
VITAS can help.

What is sepsis or septic shock?

Sepsis is a life-threatening condition that arises when the body’s immune
system responds inadequately to an infection, a response that damages the
body’s own tissues and major organs. Most sepsis-related infections are
caused by bacteria, but they can also stem from fungi, viruses or
parasites. The bloodstream, lungs, brain, urinary tract, skin and abdominal
organs are the most common locations for a primary sepsis infection.

Sepsis is classified into three stages, and if a referral to hospice is
necessary, it should be made quickly.

1. Sepsis
is the initial infection, which sets off an inflammatory immune
response that affects the entire body. Most people recover from mild
sepsis if antibiotics, fluids and supportive treatments are started
early, preferably within hours of diagnosis.

2. Severe sepsis impacts and impairs blood flow to vital organs, including the brain,
heart and kidneys. It can also cause blood clots to form in internal
organs, arms, fingers, legs and toes, leading to varying degrees of
organ failure and gangrene (tissue death). Among hospitalized patients,
sepsis is the leading cause of death (34%).1 Symptoms of
severe sepsis include:

Doctors rely on a variety of factors and tests to identify the source of
the infection and diagnose sepsis, including temperature, heart rate,
respiratory rate, blood/platelet counts, biomarker analysis and other
cultures/tests.

Who is most at risk for sepsis or septic shock?

Some patients are more susceptible than others, including those who:

Are very young or very old

Are suffering from a chronic illness or a drug-resistant bacterial
infection

Have underlying illnesses (40% of hospitalized patients) that would
make them eligible for hospice care, including advanced cancer, heart
failure, advanced lung disease (shortness of breath at rest or with
minimal exertion, with or without oxygen), and dementia accompanied by
any difficulty with activities of daily living (eating, bathing,
dressing, toileting, personal hygiene, etc.)

Rely on invasive devices, including intravenous catheters, breathing
tubes or ventricular assist devices for the heart

What patients and families should know about sepsis, and how hospice
can help

Patients are eligible for hospice care when a physician makes a clinical
determination that life expectancy is six months or less if the condition
or disease runs its expected course.

Many sepsis infections, however, occur in patients who are already
seriously ill, hospitalized, in the intensive care unit (ICU) or recovering
from a hospital procedure. However, elderly or debilitated patients may be
successfully managed and discharged to outpatient care to only begin a
persistent and progressive decline from the latent effects of this
insidious disease. Ideally, patients who develop sepsis and have survived
the initial hospitalization from sepsis, but are now experiencing decline,
should be evaluated for participation in goals-of-care conversations. These
conversations serve to identify their preferences for end-of-life care. If
eligible, hospice care is the most care these individuals can receive at
home.

Hospice admissions personnel should be contacted immediately when severe
progressive sepsis is diagnosed, because time is of the essence when a
potentially rapid, progressive infection occurs late in the disease
progress or in patients whose health is already unstable or compromised. If
sepsis does not result in the patient’s death, hospice care may be the best
option to manage long-term symptoms, address pain and support the patient
and family.

Here are some tips for families and patients who face the challenges of
serious illness, hospitalization or numerous procedures that put them at
risk of sepsis:

Make your wishes known now: Talk about them, write them down, share
them.
If you are a patient at risk for sepsis, make sure to document your wishes
and preferences for end-of-life care now, before a crisis arises. Decide
what interventions you want and do not want if you face a life-limiting
diagnosis or a potentially deadly infection like sepsis. When you have
completed advance directives, such as a living will or durable power of
attorney for healthcare decisions, your family, healthcare proxy and
healthcare team can make decisions about end-of-life care without
disagreement or guilt.